"On this earth there are pestilences and there are victims ... one must refuse to be on the side of the pestilence"—Camus

March 25, 2015

Since the Ebola outbreak in West Africa was officially declared on 22 March in Guinea, it has claimed more than 10,236 lives in the region. The outbreak is the largest ever, and is currently affecting three countries in West Africa: Guinea, Liberia and Sierra Leone. Outbreaks in Mali, Nigeria and Senegal have been declared over. A separate outbreak in DRC has also ended.

The epidemic is not yet over

In Guinea and Sierra Leone there were still about 150 new cases between March 8 and 15. The vast majority of them are concentrated in Conakry, Freetown and the surrounding regions.

The number of weekly cases is still by far higher than in any other previous outbreak. At the beginning of March in Guinea, less than 30% of cases came from identified contact chains.

One case can be enough to reignite the epidemic.

Two ‘pillars’ of the response are still missing – and key to hope getting to zero cases

Regional cooperation: Given the high mobility of the population across the three most-affected countries, surveillance must be ensured across borders and coordinated on the regional level to avoid new cases to be ‘imported’ in Ebola-free zones.

Community awareness remains low in some areas, raising the risk of local people panicking, which can lead to violence against medical and aid workers. Community mobilization and sensitisation efforts supported by national and local leaders must be reinforced rapidly.

Non-Ebola needs are a persisting concern

Already weak public health systems have been seriously damaged by the epidemic. In Liberia and Sierra Leone, many hospitals have shut and there are very few places for the non-Ebola sick to turn for help.

The long period of interrupted health services has caused significant gaps in preventive activities, such as routine immunization of children, and in retention in care for people on long-term treatments such as HIV and other chronic diseases. There is a need to catch up and mitigate the consequences of the treatment interruption.

March 23, 2015

The US Government, learning from the immediate past experience of the outbreak of the Ebola Virus Disease in West Africa and its devastating human cost, has announced an ambitious plan to construct an annex of its Center for Disease Control and Prevention (CDC) in Liberia and two others in Guinea and Sierra Leone.

According to CDC’s Deputy Director for Ebola Response to Liberia, Desmond Williams, the move is in an effort to quickly detect and control any infectious disease outbreak in the future.

Speaking at first National Conference on Ebola in Monrovia, recently, Dr. Williams disclosed that the CDC is poised to establish offices in Liberia, Guinea and Sierra Leone to counter the recurrence of the Ebola virus or the outbreak of any other infectious disease.

He was serving as one of three panelists at the conference. The US health practitioner, who has a Sierra Leonean background, noted that the CDC’s local office will help the Ministry of Health develop a surveillance system and the collection and storing of data for relevant infectious disease control purposes.

Dr. Williams indicated that Development Laboratories, which help with early detection and help quickly contain the outbreak of diseases, exist throughout the world and the CDC will ensure that similar facilities are established in Liberia and the rest of the Mano River Union (MRU) basin.

Contributing, moderator Deputy Head of the Incident Management Team, Dr. Francis Kateh, indicated that the issue of surveillance is very critical to detecting and containing infectious diseases, especially as Liberia has very porous borders with its neighbors.

Dr. Kateh said the EVD had a devastating impact as a result of the lack of proper surveillance systems in the three countries.

March 18, 2015

Guinea has suffered a setback in its fight against Ebola with a rash of new cases, including three doctors infected by the virus, with officials blaming weak surveillance and a failure to follow safety procedures.

The outbreak, which began in eastern Guinea more than a year ago and has killed over 10,000 people in the three West African countries worst hit, had appeared to be on the wane, but Guinea has seen cases rise for three consecutive weeks, according to World Health Organization data.

A government health report from the weekend showed there were 21 new cases in a single day, a spike from the recent daily average of eight.

President Alpha Conde said on Tuesday that everything must be done to end the outbreak by mid-April, ahead of a meeting with donors scheduled around that date.

Ending Ebola could reboot Guinea's mining-dependent economy that has been hammered by the outbreak which has scared investors, he said.

"With Ebola, it is easier to go from 100 cases to 10 cases than from 10 cases of to zero. To end it, we need ten times more effort than when the outbreak was at its height," he said.

NEW INFECTIONS

A big source of concern is a chain of new infections that can be linked back to a woman who died of Ebola and was not buried safely, according to Fatoumata Lejeune-Kaba, spokeswoman for the U.N.'s Ebola emergency response mission UNMEER.

"It's a major setback .... It's due to individual behaviors. That is having a devastating effect on the community. People are simply not practicing the safety rules that we have been talking about for a year," she told Reuters.

Of the other two countries worst hit, Sierra Leone has also seen a spate of new cases while Liberia has no known cases at present and is waiting to be declared free of the disease.

The new cases in Guinea are in the capital and the southwestern town of Forecariah but if the situation is not brought under control they could spread across borders, said Lejeune-Kaba.

Guinea officials said the new cases came from high risk Ebola contacts who had left Forecariah and developed symptoms elsewhere, pointing to poor surveillance.

Sakoba Keïta, Guinea's anti-Ebola task force coordinator, said on Tuesday that the government was putting in place new measures including strict rules regulating the movement of corpses and contact tracing.

March 11, 2015

• A total of 116 new confirmed cases of Ebola virus disease (EVD) were reported in the week to 8 March, compared with 132 the previous week. Liberia reported no new confirmed cases for the second consecutive week. New cases in Guinea and Sierra Leone occurred in a geographically contiguous arc around the coastal capital cities of Conakry and Freetown, with a total of 11 districts reporting cases. Although there has been no significant decline in overall case incidence since late January, the recent contraction in the geographical distribution of cases is a positive development, enabling response efforts to be focused on a smaller area.

• Guinea reported 58 new confirmed cases in the week to 8 March, compared with 51 cases the previous week. Cases were clustered in an area around and including the capital Conakry (13 cases), with the nearby prefectures of Boffa (2 cases), Coyah (8 cases), Dubreka (5 cases), Forecariah (28 cases), and Kindia (2 cases) the only other prefectures to report cases.

• Sierra Leone reported 58 new confirmed cases in the week to 8 March; the first time since June 2014 that weekly incidence has not exceeded that of Guinea. Cases were reported from 5 north and western districts clustered around the capital Freetown, which reported 27 new confirmed cases. The neighbouring districts of Bombali (6 cases), Kambia (7 cases), Port Loko (12 cases) and Western Rural (6 cases) also reported cases.

• In the 4 days to 5 March there were 90 reported suspected cases in Liberia, none of whom tested positive for EVD, indicating that vigilance is being maintained. A total of 102 contacts were being followed up.

• The number of confirmed EVD deaths occurring in the community has risen for the past 3 weeks in Guinea, suggesting that there are still significant challenges in terms of contact tracing and community engagement. Of a total of 40 EVD-positive deaths reported in the week to 8 March, 24 occurred in the community. By contrast, a far smaller proportion of EVD-positive deaths occurred in the community in Sierra Leone: 11 of 83. A total of 13 unsafe burials were reported from Guinea and 2 from Sierra Leone over the same period.

• In the week to 1 March, 7 of 51 (14%) confirmed cases of EVD reported from Guinea arose among known contacts of previous cases, indicating that there are a large number of untraced contacts associated with known chains of transmission, and that unknown chains of transmission persist. In Sierra Leone, by contrast, 52 of 81 (64%) of confirmed EVD cases arose among known contacts over the same period. The average daily number of contacts traced in the week to 8 March was 1433 in Guinea, compared with 7934 in Sierra Leone.

• The relatively low proportion of cases arising among known contacts, the relatively high proportion of EVD-positive deaths that occur in the community, and the continued occurrence of unsafe burials in Guinea are all indicative of continued difficulties engaging effectively with affected communities. A total of 7 Guinean prefectures reported at least one security incident in the week to 8 March.

• During the week to 1 March, five cross-border meetings took place, including a coordination meeting in Kambia and Forecariah to facilitate communication, share best practices, and align strategies.

• In the week to 8 March, 1 new health worker infection was reported in Guinea, bringing the total number of health worker infections reported across the three most-affected countries since the start of the outbreak to 840, with 491 deaths.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION

• There have been over 24 000 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (table 1), with almost 10 000 reported deaths (outcomes for many cases are unknown). A total of 58 new confirmed cases were reported in Guinea, 0 in Liberia, and 58 in Sierra Leone in the 7 days to 8 March (4 days to 5 March for Liberia).

• The total number of confirmed and probable cases is similar in males and females (table 2). Compared with children (people aged 14 years and under), people aged 15 to 44 are approximately three times more likely to be affected. People aged 45 and over are nearly four times more likely to be affected than children.

• A total of 840 confirmed health worker infections have been reported in the 3 intense-transmission countries; there have been 491 reported deaths (table 4).

March 07, 2015

The Ministry of Health still has a ban in place on health workers traveling to Ebola-hit nations, a leading doctor said here recently.

The ban continues because the disease is highly contagious and health workers are the most likely to be infected if they are involved in treating such patients, said Tamari Al-Tayeb, the doctor who heads the ministry’s Ebola task team.

Al-Tayeb said the ministry has not picked up anyone infected with Ebola in the Kingdom. Health personnel have been deployed to the nation’s land and sea ports so that they can check travelers entering the country, she said.

Several people suspected of having the virus have already been isolated and tested to see whether they are infected. The virus was initially spread from wild animals to people, and then between people, and is thought to have originated in West African countries, she said.

While the Kingdom’s health practitioners are not allowed to travel to these countries, the Saudi government has assisted in fighting the outbreak by sending beds, medication and tents to affected countries, she said.

February 27, 2015

Efforts to beat Ebola in Sierra Leone have been dealt a setback after 31 new cases were recorded in one village.

The community of 500 just outside the town of Makeni has now been put in lockdown by the army amid fears that more could be infected.

The World Health Organisation said cases have been linked to one man who escaped a quarantine in Freetown to go home to his village to get treatment from a traditional faith healer.

The quarantine area is a fishing community, yards from the hotel where many of humanitarian agencies have stayed.

“On Sunday we had just five patients, it was really quiet,” said Bill Boyes, spokesman for the International Medical Corps (IMC) in Makeni.

“Then all of a sudden the ambulances started arriving and we had 16 people and it hasn’t stopped since. I think we have about 50 patients with 31 confirmed Ebola cases,” he said.

It is the busiest the 100-bed centre has been since it opened in December, with confirmed cases spilling out into an empty convalescent ward.

Most of the patients are part of the fisherman’s extended family.

The flare-up comes less than a week after the country recorded just two new cases of Ebola, the lowest since the virus first hit the country in May last year.

Boyes said he believed the rapid response will contain the disease to the village. “We had kind of being expecting it. It had been tailing off, but all it takes is one person.

“I was out in the village yesterday and the surveillance is really good, but this was just one person not heeding the advice. He knew he was sick and in danger and maybe he was just scared and wanted to go home.”

“I was in the village yesterday and you can smell the fear in the air.”

​Upon reassessing the risk of Middle East respiratory syndrome coronavirus (MERS-CoV) to Europe, ECDC’s conclusion remains that the MERS-CoV outbreak poses low risk to the EU. There is continued risk of importation of cases to Europe after exposure in the Middle East. The risk of sustained human-to-human transmission in Europe remains very low.

ECDC reviews its assessment as the incidence of Middle East respiratory syndrome coronavirus (MERS-CoV) cases has been on the rise in Saudi Arabia since December 2014. This increase parallels a similar increase observed in early 2014 and may indicate to a seasonal pattern in MERS-CoV transmission.

Growing evidence points to the role of dromedary camels as a reservoir of MERS-CoV and the direct transmission of the virus, at a low transmission rate, from infected camels to humans. This increased transmission from an animal source is amplified by nosocomial transmission, as one third of the recent cases may have a nosocomial origin.

The recent importation of a MERS-CoV case in the Philippines demonstrates the possibility of imported cases, especially in relation with healthcare workers infected while caring for patients in Saudi Arabia.

Because of the continued risk of cases in Europe after exposure in the Middle East, international surveillance for MERS-CoV remains essential.

Sensitisation of first-line healthcare staff to the fact that MERS-CoV is circulating in the Middle East is prudent, to detect any imported cases timely as well as ensure rapid implementation of infection control measures.

February 18, 2015

WHO has published Ebola Situation Report - 18 February 2015. As always, this is a much more detailed account than the daily numbers (I wish PAHO would do something similar for chikungunya and cholera). The summary:

• A total of 128 new confirmed cases of Ebola virus disease (EVD) were reported in the week to 15 February. Guinea reported 52 new confirmed cases – a decrease from the previous week, and the first week-to-week decline since January 25. Transmission remains widespread in Sierra Leone, with 74 new confirmed cases, and is most intense in the capital, Freetown, which reported 45 confirmed cases. Liberia reported 2 new confirmed cases in the 4 days to 12 February.

• Engaging effectively with communities has been one of the keys to successfully driving cases to zero in many parts of Guinea, Liberia, and Sierra Leone, but continues to present a challenge in several areas. Each of the three countries reported an increase in security incidents related to the Ebola response compared with the previous week. In Guinea and Sierra Leone, 39 and 45 unsafe burials were reported, respectively, in the week to 15 February, and over 40 new confirmed cases were identified only when testing was carried out on samples from individuals after they died in the community, away from treatment facilities. Not only have these individuals not received potentially life-saving treatment, but other members of the community have been put at greater risk of exposure to EVD than they would have been had those individuals been isolated when they first showed symptoms. Contact tracing also relies on the cooperation of affected communities; when this cooperation is not secured, the vital task of tracking chains of transmission becomes much more difficult. Recent success in engaging with communities in the eastern Guinean prefecture of Lola enabled responders to trace cases and contacts related to an unsafe burial, and rapidly bring a localised outbreak under control. Similar breakthroughs must now be made in the remaining areas of transmission.

• Most of the new confirmed cases reported by Guinea were in the capital, Conakry (13 confirmed cases), and the western prefecture of Forecariah (24 confirmed cases). The north Guinean prefecture of Mali, which borders Senegal, reported 2 new confirmed cases.

• A mission to strengthen surveillance in the border areas of Côte d’Ivoire is ongoing. Further preparedness missions are planned for Guinea Bissau, Mali, Senegal later this month to strengthen cross-border surveillance.

• A total of 2 confirmed cases were reported from Liberia. All of the cases originated from the same area of Montserrado county, linked to a single chain of transmission.

• Following the steep decline in case incidence in Sierra Leone from December until the end of January, incidence has now stabilized. A total of 74 cases were reported in the week to 15 February, compared with 76 confirmed cases in the previous week.

• The case fatality rate among hospitalized cases (calculated from all confirmed hospitalized cases with a reported definitive outcome) remains high, at between 53% and 64% in the 3 affected countries.

February 14, 2015

Following the decrease of new Ebola cases during the first four weeks of 2015, numbers in Conakry rose again and went from 9 confirmed cases (January 30) to 18 confirmed cases as of February 10. Moreover, with many of the country’s prefectures considered as “active”, the epidemic is still geographically spread out. New chains of transmission have been reported in areas previously considered as Ebola-free.

MSF deployed rapid response teams that are able to quickly identify, investigate and follow new cases and contacts, as well as quickly setting up isolation units within existing health structures. The number of unreported community death and unsafe burials remains concerning, especially in Conakry. Outreach activities, (active) surveillance, social mobilization and training are ongoing in all projects.

Conakry

There has been an increase in cases with 17 patients at Donka CTE. MSF continues outreach and community sensitization activities in the city but the level of acceptance remains low. The capacity of the non-MSF ETC at Coyah reached its limit with 23 patients during the weekend. Patients from the areas surrounding Coyah were therefore referred to Donka.

Guéckédou

With 1 new admission during the last days, the number of patients remains low. MSF launched a support intervention in the nearby town of Kissidougou, where sensitization activities, support to the surveillance team and health structure evaluation are ongoing.

Preliminary results of the favipiravir trial led by INSERM have been announced. However, it is too soon to draw conclusion on the efficacy of the drug. Therefore the trial is still ongoing.

Rapid Response Teams – Faranah

The rapid response team is currently setting up a transit centre in Faranah to facilitate the individuation and referral of new cases. The team is also involved in surveillance and support to local health structures, and is conducting community sensitisation activities.

Although the number of Ebola cases in West Africa have decreased during the last weeks, control efforts in the affected countries needs to be maintained to continue the significant drop and eventually achieve zero cases. To contribute to the field work related to surveillance activities and contact tracing, ECDC has already deployed experts and is opening today a call for external experts to join the teams in Guinea.

The Ebola outbreak in West Africa

The outbreak of Ebola Virus Disease evolving in Guinea, Liberia and Sierra Leone during the last 12 months has so far resulted in 22 523 cases, including 8 994 deaths.

While the epidemic seems to have peaked in all three countries, the outbreak will be over only when the last contact of the last case has been monitored for 21 days and declared not infected. Some areas are experiencing small outbreaks, and the situation is not yet under control. A resurgence of cases and the epidemic is still possible.

Surveillance and epidemiological activities in the field should hence be continued to ensure complete contact tracing and the adequate management of new infections, states the latest ECDC risk assessment.

ECDC engagement in the field operations

Since December 2014, the ECDC has been engaging in the field operations related to the Ebola outbreak response in West Africa by mobilising and coordinating field epidemiology teams in Guinea.

Composed of experts from EU Member States, EPIET and EUPHEM fellows and alumni and ECDC staff members, the teams provide technical support and leadership for the response activities in the field. The field experts contribute to and coordinate case detection, contact tracing and monitoring, collection and analysis of descriptive epidemiology, quality assurance and training of national staff engaged in the Ebola response). They are localised in the Guinée Forestière region and operate under the umbrella of WHO.

ECDC call for epidemiologists to join the teams in Guinea

The ECDC is now looking for external experts who can support the ECDC teams in Guinea for periods of six weeks until the end of June 2015, the selected experts should be:

• experienced epidemiologists,

• fluent in French,

• available to deploy on short notice.

The experts will be formally employed by WHO as short term consultants and will be responsible for:

• supervision of less experienced field epidemiologists,

• planning and executing activities,

• coordination with national authorities, the WHO office in Conakry and local and international partners engaged in the response to Ebola.